Objective:To evaluate the clinical outcomes of combined complete preservation of chordal structure mitral valve replacement (C-MVR) with total anatomical arterial myocardial revascularization (TACR) in coronary patients with moderate-to-severe or severe ischemic mitral regurgitation (IMR).Methods:This is a retrospective multi-center case series study. Data were retrospectively collected from 127 patients with coronary artery disease with moderate to severe or severe IMR who received TACR with C-MVR from July 2015 to April 2024 in 13 hospitals in China. There were 90 males and 37 females, aged (56.5±10.7) years (range: 33 to 74 years). Perioperative data and follow-up data including left ventricular ejection fraction, left ventricular end-diastolic diameter, and patency rate of arterial grafts of patients were collected. Comparisons were made using paired sample t-test or χ2 test. Results:In this cohort of 127 patients, 67 underwent concurrent tricuspid valve repair. During surgery, 113 grafts of the left internal mammary artery (LIMA), 127 grafts of the left radial artery, 80 grafts of the right radial artery, and 110 grafts of the right internal mammary artery (RIMA) were harvested. The number of the distal anastomosis was 4.2±0.4 (range: 3 to 5). The aortic cross-clamp time and cardiopulmonary bypass time were (97.5±23.4) minutes (range: 90 to 161 minutes) and (145.4±19.2) minutes (range: 101 to 210 minutes), respectively. There was one operative death. Intraoperative placement of an intra-aortic balloon pump was performed in 21 patients to improve the left ventricular ejection. No sternal ischemic occurred. All patients completed follow-up, with a mean follow-up period of (64.3±7.5) months (range: 4 to 110 months). No major cerebrovascular events occurred during the follow-up period, and all patients survived. Left ventricular ejection fraction improved postoperatively (55.0%±5.3% vs. 41.0%±15.3%, t=17.23, P<0.01). The proportion of patients with New York Heart Association functional class ≤2 increased postoperatively (23.6% (30/127) vs. 87.3% (110/126), χ2=103.77, P<0.01). The proportion of patients with Canadian Cardiovascular Society Angina Classification ≤3 decreased postoperatively (4.8% (6/126) vs. 78.7% (100/127), χ2=142.19, P<0.01). The left ventricular end-diastolic diameter decreased postoperatively ((5.70±4.50) cm vs. (6.10±0.23) cm, t=12.15, P<0.01). Coronary multi-detector computed tomography angiography (MDCTA) follow-up was conducted for (60.5±11.7) months (range: 6 to 109 months) postoperatively. MDCTA confirmed the patency rates of the grafts: 96.4% (108/112) for the LIMA grafts, 88.9% (112/126) for the left radial artery grafts, 93.7% (74/79) for the right radial artery grafts, and 90.9% (100/110) for the free RIMA grafts. No significant differences in graft patency rates were observed between the arterial grafts ( χ2=5.24, P=0.155). Conclusion:The results of this multi-centre study demonstrate satisfactory mid-term results of C-MVR with TACR for the treatment of coronary artery disease with moderate to severe or severe IMR.

Objective:To evaluate the clinical outcomes of combined complete preservation of chordal structure mitral valve replacement (C-MVR) with total anatomical arterial myocardial revascularization (TACR) in coronary patients with moderate-to-severe or severe ischemic mitral regurgitation (IMR).Methods:This is a retrospective multi-center case series study. Data were retrospectively collected from 127 patients with coronary artery disease with moderate to severe or severe IMR who received TACR with C-MVR from July 2015 to April 2024 in 13 hospitals in China. There were 90 males and 37 females, aged (56.5±10.7) years (range: 33 to 74 years). Perioperative data and follow-up data including left ventricular ejection fraction, left ventricular end-diastolic diameter, and patency rate of arterial grafts of patients were collected. Comparisons were made using paired sample t-test or χ2 test. Results:In this cohort of 127 patients, 67 underwent concurrent tricuspid valve repair. During surgery, 113 grafts of the left internal mammary artery (LIMA), 127 grafts of the left radial artery, 80 grafts of the right radial artery, and 110 grafts of the right internal mammary artery (RIMA) were harvested. The number of the distal anastomosis was 4.2±0.4 (range: 3 to 5). The aortic cross-clamp time and cardiopulmonary bypass time were (97.5±23.4) minutes (range: 90 to 161 minutes) and (145.4±19.2) minutes (range: 101 to 210 minutes), respectively. There was one operative death. Intraoperative placement of an intra-aortic balloon pump was performed in 21 patients to improve the left ventricular ejection. No sternal ischemic occurred. All patients completed follow-up, with a mean follow-up period of (64.3±7.5) months (range: 4 to 110 months). No major cerebrovascular events occurred during the follow-up period, and all patients survived. Left ventricular ejection fraction improved postoperatively (55.0%±5.3% vs. 41.0%±15.3%, t=17.23, P<0.01). The proportion of patients with New York Heart Association functional class ≤2 increased postoperatively (23.6% (30/127) vs. 87.3% (110/126), χ2=103.77, P<0.01). The proportion of patients with Canadian Cardiovascular Society Angina Classification ≤3 decreased postoperatively (4.8% (6/126) vs. 78.7% (100/127), χ2=142.19, P<0.01). The left ventricular end-diastolic diameter decreased postoperatively ((5.70±4.50) cm vs. (6.10±0.23) cm, t=12.15, P<0.01). Coronary multi-detector computed tomography angiography (MDCTA) follow-up was conducted for (60.5±11.7) months (range: 6 to 109 months) postoperatively. MDCTA confirmed the patency rates of the grafts: 96.4% (108/112) for the LIMA grafts, 88.9% (112/126) for the left radial artery grafts, 93.7% (74/79) for the right radial artery grafts, and 90.9% (100/110) for the free RIMA grafts. No significant differences in graft patency rates were observed between the arterial grafts ( χ2=5.24, P=0.155). Conclusion:The results of this multi-centre study demonstrate satisfactory mid-term results of C-MVR with TACR for the treatment of coronary artery disease with moderate to severe or severe IMR.

Objective To investigate the role of quality control circle management guided by Party building philosophy in improving patient satisfaction in emergency services.Methods Quality control circle management guided by the Party building philosophy was implemented in May 2023.Two groups of 1 000 emergency patients each were selected,one from April to May 2023(pre-implementation)and the other from April to May 2024(post-implementation).The control group and the observation group were compared across several metrics in terms of satisfaction scores,satisfaction rates,120 emergency call response time,3-minute pre-hospital emergency dispatch rates,and average waiting times for emergency observation patients.Results The ob-servation group demonstrated higher satisfaction scores,satisfaction rates,and higher 3-minute pre-hospital emergency dispatch rates compared to the control group.Additionally,the observation group had shorter emergency call response time and average waiting time in the emergency department,with statistically significant differences(P＜0.05).Conclusion The integration of quality control circle management guided by Party construction philosophy in the management of emergency patients has been shown to address operational issues,optimize service processes,and significantly improve patient satisfaction and experience.This method is worthy of broader application and promotion in clinical practice.

There are more than 1 billion patients worldwide suffering from hepatobiliary diseases, yet there remains a scarcity of successful practices and frameworks in standardizing, inte-grating, and sharing disease data. In response to this challenge, Beijing Tsinghua Changgung Hospital affiliated to Tsinghua University, in collaboration with various medical and information technology institutions, has developed the 'Blockchain-Based Hepatobiliary Disease Data Extraction and Exchange' standard. This standard, known as the IEEE 3806-2023 standard, is establishing China′s first inter-national standard for the application of hepatobiliary disease data. The authors elucidate the origins, application scope, key contents, and clinical significance of this standard, with the aim of aiding medical establishments, pharmaceutical companies, and other stakeholders in comprehending the data extraction and exchange standard for hepatobiliary diseases, thereby facilitating its wider adop-tion and implementation.

Purpose: Myofibroblastic cancer-associated fibroblasts (myCAFs) are important components of the tumor microenvironment closely associated with tumor stromal remodeling and immunosuppression. This study aimed to explore myCAFs marker gene biomarkers for clinical diagnosis and therapy for patients with bladder cancer (BC). Materials and Methods: BC single-cell RNA sequencing (scRNA-seq) data were obtained from the National Center for Biotechnology Information Sequence Read Archive. Transcriptome and clinical data were downloaded from The Cancer Genome Atlas and the Gene Expression Omnibus databases. Subsequently, univariate Cox and LASSO (Least Absolute Shrinkage and Selection Operator regression) regression analyses were performed to construct a prognostic signature. Immune cell activity was estimated using single-sample gene set enrichment analysis whilst the TIDE (tumor immune dysfunction and exclusion) method was employed to assess patient response to immunotherapy. The chemotherapy response of patients with BC was evaluated using genomics of drug sensitivity in cancer. Furthermore, Immunohistochemistry was used to verify the correlation between MAP1B expression and immunotherapy efficacy. The scRNA-seq data were analyzed to identify myCAFs marker genes. Results: Combined with bulk RNA-sequencing data, we constructed a two-gene (COL6A1 and MAP1B) risk signature. In patients with BC, the signature demonstrated outstanding prognostic value, immune infiltration, and immunotherapy response. This signature served as a crucial guide for the selection of anti-tumor chemotherapy medications. Additionally, immunohistochemistry confirmed that MAP1B expression was significantly correlated with immunotherapy efficacy. Conclusions Our findings revealed a typical prognostic signature based on myCAF marker genes, which offers patients with BC a novel treatment target alongside theoretical justification.

Aberrant expression of annexin A2-S100A10 heterotetramer (AIIt) associated with PML/RARα fusion protein causes lethal hyperfibrinolysis in acute promyelocytic leukemia (APL),but the mechanism is unclear.To facilitate the investigation of regulatory association between ANXA2 and promyelocytic leukemia/retinoic acid receptor α (PML/RARα) fusion protein,this work was performed to determine the transcription start site of ANXA2 promoter with rapid amplification of S'-cDNA ends analysis.Zinc-induced U937/PR9 cells expressed PML/RARα fusion protein,and resultant increases in ANXA2 transcripts and translational expressions of both ANXA2 and S100A10,while S100A10 transcripts remained constitutive.The transactivation of ANXA2 promoter by PML/RARα fusion protein was 3.29 ± 0.13 fold higher than that by control pSG5 vector or wild-type RARα.The overexpression of ANXA2 in U937 transfected with full-length ANXA2 eDNA was associated with increased S100A10 subunit,although S100A10 transcripts remained constitutive.The tPA-dependent initial rate of plasmin generation (IRPG) in zinc-treated U937/PR9 increased by 2.13-fold,and cell invasiveness increased by 27.6％.Antibodies against ANXA2,S100A10,or combination of both all remarkably inhibited the IRPG and invasiveness in U937/PR9 and NB4.Treatment of zinc-induced U937/PR9 or circulating APL blasts with all-trans retinoic acid (ATRA) significantly reduced cell surface ANXA2 and S100A10 and associated reductions in IRPG and invasiveness.Thus,PML/RARα fusion protein transactivated the ANXA2 promoter to upregulate ANXA2 and accumulate S100A10.Increased AIIt promoted IRPG and invasiveness,both of which were partly abolished by antibodies against ANXA2 and S100A10 or by ATRA.

A systematic summary of the concept and operational mechanism of the intensive disciplines management in a hospitals group,and that of the intensive disciplines management for hospitals groups,as well as a comparison of the differences found in department service capacity,service quality,discipline development and patient satisfaction before and after the intensive discipline management is in place.The practice proved that the departments practicing intensive management have witnessed significant rise in outpatient headcount,hospitalization headcount and surgical operation headcount.Their weight in the group is also higher.For example,their curative rate and rescue success rate of dubious and acute diseases higher than before (P＜ 0.05).The Group has 8 provincial key medicine-specialties,including 5 intensive management departments.It has 8 provincial key clinicaldisciplines,including 2 intensive management departments.The overall patient satisfaction for service of such departments is 92.1％,the satisfaction for convenience is 84.4％,that for service quality 90.0％,that for service attitude 92.5％,and that for medical service experience is 89.5％.All of which are significantly higher than that those on their admission to the hospital.The intensive management has enabled unified management of internal medicine and surgery of the same profession in the campus,integrated workforces of both internal medicine and surgery department along with those of medical technicians.In addition,it has enhanced departmental service capacity and quality,discipline competence,as well as outpatients' convenience,patients' satisfaction and medical experience.

Objective To explore the effectiveness of the home-community-hospital network management (HCHNM) on the prevention and treatment of stroke.Methods From June to December 2011,HCHNM was implenented in Qingdao of Shandong Province to prevent and treat stroke patients.According to community residents healthcare records,A total of 80 stroke patients were randomly selected from Badahu and Fushanhou communities (study group) and another 80 patients from Zhongshan Road and Liaoning Road communities (control group).A household questionnaire survey was then conducted among these participants.Chi-square test and t test were used for data analysis.Results The overall effective rate of the study group was 86.25％ (69/80),which was significantly higher than that of the control group (67.5％) (x2=221.807,P＜0.05).The study group also showed largely improved quality of life (total score:t=4.593;physical fitness,family activities,movement,mood,self-care ability,social activities,upper limb function and work ability scores:t values were 7.775,2.244,5.329,3.832,5.463,2.979,5.924 and 3.555,respectively; all P＜0.05),although language,character,thinking and vision abilities had no statistically significant difference from the control group (t values were 0.561,1.466,0.831 and 1.000,respectively; all P＞0.05).The scores of daily activities and life satisfaction of the study group were higher than those of the control group,while per capita medical cost was much lower (t values were 12.998,20.760 and-29.777,respectively; all P＜0.05).Conclusions As an effective,safe and economy therapy model,HCHNM could improve rehabilitation,self-care ability,quality of life,and life satisfaction of community stroke patients.In addition,it greatly mitigates medical burden.

Objective To detect the expressions of COX-2 and VEGF-C in breast cancer and to explore the relationship between their expressions and lymphatic metastasis. Methods Immunohistochemical stai- ning (SABC) was used to detect the expressions of COX-2 and VEGF-C proteins in 60 cases of breast canc- er. Results The positive rate of COX-2 and VEGF-C in breast cancer were 66.7% and 60. 0%, and the expression of COX-2 was positively correlated with VEGF-C (r =0.429, P<0.05). COX-2 and VEGF-C expressions were positively correlated with lymphatic metastasis (P<0.05). The lymphatic metastasis rate in the positive group of COX-2 and VEGF-C were higher than that in the negative group of COX-2 and VEGF-C. Conclusion Over expression of COX-2 and VEGF-C were observed in breast cancer, and closely related to lymphatic metastasis. COX-2 has positive correlation with VEGF-C and was correlated with lym- phatic metastasis of breast cancer. COX-2 may promote the over expression of VEGF-C in tumor cells and cause lymphatic metastasis.

BACKGROUND: The area of myocardial infarction is the determinative factor of acute myocardial infarction prognosis. Amelioration of blood transportation and replacement therapy can reduce infarction area. Bone marrow mesenchymal stem cells can differentiate into cardiovascular tissue and are easy to obtain. After cultured and expanded in vitro, they can become the ideal cells for cardiovascular replacement therapy.OBJECTIVE: To evaluate the therapeutic effect of intracoronary transplantation of bone marrow mesenchymal stem cells in the treatment of myocardial infarction. DESIGN: Self-control observation taking the patients as subjects.SETTING: Department of Cardiology, Department of Nuclear Medicine,Echocardiogram Room, Nanjing First Hospital Affiliated to Nanjing Medical University.PARTICIPANTS: Totally 20 patients with acute myocardial infarction who received the therapy of bone marrow mesenchymal stem cells transplantation in the Department of Cardiology, Nanjing First Hospital Affiliated to Nanjing Medical University during March 2003 to March 2004 were recurited. Informed consents were obtained from the patients, and the complete postoperative follow up was over 3 months. The patients include 15 male and 5 female, and they were aged (64±10) years.METHODS: All the patients underwent percutaneous coronary intervention (PCI) to treat infarction-related blood vessel. Autologous bone marrow was taken from the patients, then stem cells were extracted to be performed in vitro induction, differentiation and proliferation, and transplanted infarction-related blood vessel through coronary artery at the mean number of (21.7±30.14)× 107 within 2 weeks. Before and 3 months after transplantation of stem cells, patients underwent gated dual-isotopic myocardial perfusion/metabolic imaging (18-fluoro-2-deoxy-glucose, 18F-FDG) examination. Survived and necrotic myocardia were predicted and infarction area was obtained. At the same time, wall motion and heart function index were evaluated with ultrasound cardiography (UCG)examination, and they were re-checked 3 months after operation to evaluate the amelioration of wall motion and heart function index. A 5-point scale was used in the evaluation of gated dual-isotopic myocardial perfusion/metabolic imaging (18F-FDG) examination: point 0: normal, 1: sparse, 2:obviously sparse, 3: defected. Evaluative standard of UCG: point 1: normal,2: reduced, 3: obviously reduced, 4: no ventricular wall motion or paradoxical motion; Wall motion with 2 points or more than 2 points suggests it is improved.MAIN OUTCOME MEASURES: ① Results of gated dual-isotopic myocardial perfusion/ metabolic imaging (18F-FDG-SPECT); ②Infarctionrelated myocardial segment score and heart function index before and after stem cell transplantation of patients in ECG follow-up observation.RESULTS: All the 20 patients participated in the result analysis.Results of gated dual-isotopic myocardial perrusion/metabolic imaging (18F-FDG-SPECT): The myocardial perfusion defect area of 20 patients was significantly reduced after therapy than before therapy [(33±15)%,-(44±18)% ,P ＜ 0.05]; Metabolie defect area was significantly reduced after therapy than before therapy [(33±17)%, (43±21)% ,P ＜ 0.05];Before therapy, there were 199 segments, in which blood flow reperfusion was matched to glycometabolism defect, and they were determined as necrotic myocardium. After therapy, blood flow perfusion metabolism was improved in 79 segments, but blood flow perfusion and glycometabolism were not improved significantly in 120 segments (P ＜ 0.05). Results of UCG: ejection fraction of patients was significantly larger after therapy than before therapy [(53±8)%, (42±7)% ,P ＜ 0.05].CONCLUSION: Intracoronary transplantation of human bone marrow mesenchymal stem cells for treating myocardial infarction is simple to operate. After therapy, the infarction area is obviously reduced, myocardial blood flow perfusion and metabolism of necrotic area improve, myocardial segments without survival determined before operation reduce sigrificantly and the heart function of patients improve.